Healthcare Provider Details

I. General information

NPI: 1013314061
Provider Name (Legal Business Name): NICOLE HARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 DIXIE HWY STE 155
CLARKSTON MI
48346-2095
US

IV. Provider business mailing address

7485 WHITE LAKE RD
WHITE LAKE MI
48383-1160
US

V. Phone/Fax

Practice location:
  • Phone: 248-791-9266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007649
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225433
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: